Survivorship: Cancer After Cancer

Research shows that cancer survivors have a higher chance of getting another cancer (different from the first one) than someone who has not had cancer. It seems unfair that someone who has gone through cancer treatment could have to face another cancer diagnosis. It is important to remember that this risk is still quite low. Knowing about your risk and taking steps to reduce it can help you feel in control.

There are a few ways a cancer survivor might experience cancer again:

• A secondary cancer: these cancers are caused by the treatment you got for an earlier cancer. This is quite rare, but some treatments have a higher risk of this happening.
• A new, unrelated cancer. Just because you had one type of cancer does not mean you cannot get another type of cancer too.
• Lastly, the original cancer can come back. This is called a recurrence.

What treatments can put a survivor at risk of developing a secondary cancer?

A secondary cancer is one that is caused by cancer treatment for another cancer. This is quite rare, but you should be aware of the risk. This can be caused by certain chemotherapy and other anti-cancer medicines or radiation therapy.

• Chemotherapy and other anti-cancer medicines with this risk can include:
  • Anthracyclines (adriamycin, daunorubicin, doxorubicin, epirubicin, idarubicin, and mitoxantrone).
  • Alkylating agents (nitrogen mustard, cyclophosphamide, ifosfamide, melphalan, chlorambucil, carmustine, lomustine, busulfan, dacarbazine, bendamustine, BCNU, thiotepa).
  • Etoposide (VP-16), teniposide, cisplatin, and carboplatin.
  • CAR-T therapy.
  • Radiolabeled monoclonal antibodies (Zevalin, Azedra, and Bexxar).
  • Arsenic trioxide, thalidomide, and lenalidomide.
  • PARP Inhibitors (niraparib, rucaparib, olaparib, talazoparib).
  • Other anti-cancer medications can cause a secondary cancer. You can look at the information about any medications you got to see if they have this risk.

Radiation therapy increases the risk of cancer developing in or near the treatment field. This occurs because of healthy tissue being exposed to the radiation. Radiation is the most common cause of secondary cancer in people treated for childhood cancers. Modern radiation techniques are designed to limit this exposure, but it is not always possible to prevent all exposure and still achieve the desired outcomes.

What types of secondary cancers can occur?

• Certain anti-cancer medications can cause damage to the blood cells in the bone marrow. In rare cases, this damage can lead to leukemia or myelodysplasia (MDS) years after treatment.
  • Blood cancer caused by chemotherapy or radiation therapy typically occurs 4-10 years after treatment but can occur even later.
  • One exception is those cancers caused by etoposide (VP-16) or teniposide (two types of chemotherapy), which tend to occur within 1-3 years after therapy.
• The medication bendamustine can lead to secondary blood cancers. This medication may also cause secondary lung cancers.
• Some medicines such as ibrutinib and zanubrutinib can increase the risk of developing skin cancer.
• Radiation therapy has a risk of causing cancer in the areas included in the treatment field. These are often "solid tumors" or those affecting organs or tissues/bones. For example, women who received chest radiation for Hodgkin lymphoma are at a high risk of developing breast cancer later in life.

What other things can increase the risk of developing a secondary cancer?

The same things you may think of as increasing the risk of cancer can also increase the risk of a secondary cancer. These can include genetic risk in you or your family, a family history of cancer, an unhealthy lifestyle, or tobacco use.

What symptoms should I report to my provider?

You should report any new, unusual or persistent symptoms to your provider. These can include:

• More tired or weaker than usual.
• Shortness of breath (difficulty breathing).
• Loss of appetite.
• Weight loss.
• Chills, fever, night sweats.
• Painless swelling of a lymph node.
• Easily bruising, nose bleeds, bleeding from the gums.

Do I need to have screening for other types of cancer?

Cancer survivors are at higher risk of developing a second cancer than someone who has never had cancer. For this reason, it is important to have any cancer screenings appropriate for your age and personal and family history. Talk with your provider about which tests are right for you and at what age you should begin having them. These can include screening for breast, cervical, prostate, colon, and lung cancers. In addition, during routine health or dental exams (at any age) your healthcare provider may also look for cancers of the skin, mouth, and thyroid.

You can learn more about cancer screening tests on OncoLink.

It can be scary to learn about the late effects of cancer treatment. These complications are not common but knowing about them helps you stay healthy. You can learn more about caring for your health after cancer treatment by creating an OncoLife survivorship care plan.